Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942012000200015
Brazilian Journal of Anesthesiology
Clinical Information

Reversão de bloqueio muscular profundo com sugammadex após falha de intubação traqueal em sequência rápida: relato de caso

Reversal of profound neuromuscular blockade with sugammadex after failure of rapid sequence endotracheal intubation: a case report

Fabiano Timbó Barbosa; Rafael Martins da Cunha

http://dx.doi.org/10.1590/S0034-70942012000200015 Braz J Anesthesiol, vol.62, n2, p.283-284, 2012
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Resumo

JUSTIFICATIVA E OBJETIVOS: O sugammadex é um agente reversor superseletivo do bloqueio neuromuscular utilizado para a reversão de rocurônio e vecurônio. Este relato descreve um caso clínico em que o sugammadex foi utilizado em paciente idosa imediatamente após uso de rocurônio. RELATO DO CASO: Paciente do sexo feminino, 88 anos, 34 kg, com fratura de fêmur foi submetida à anestesia geral após tentativa falha de raquianestesia. Optou-se por indução anestésica com propofol 1,5 mg.kg-1, rocurônio 1,2 mg.kg-1, fentanil 100 mcg e lidocaína 2 mg.kg-1. Não houve sucesso nas manobras para intubação traqueal nem no posicionamento da máscara laríngea. Optou-se pelo uso de sugammadex na dose de 16 mg.kg-1 com retorno da função respiratória. CONCLUSÕES: A dose recomendada pela literatura para o sugammadex em pacientes com bloqueio profundo, 16 mg.kg-1, foi utilizada nesta paciente com reversão rápida e eficaz do bloqueio neuromuscular permitindo que a paciente fosse submetida a outro procedimento para garantir a perviedade das vias aéreas sem comprometimento clínico de seu estado geral.

Palavras-chave

BLOQUEADOR MUSCULAR, COMPLICAÇÕES

Abstract

BACKGROUND AND OBJECTIVES: Sugammadex is a reversal agent that acts as a selective antagonist of neuromuscular blockade induced by rocuronium and vecuronium. This is a case report of an elderly female patient who had sugammadex just after rocuronium induction. CASE REPORT: An 88-year-old female patient, 34 kg, presented a femoral fracture and had to undergo general anesthesia after spinal anesthesia failure. Induction was performed with propofol 1.5 mg.kg-1, rocuronium 1.2 mg.kg-1, fentanyl 100 mcg, and lidocaine 2 mg.kg-1. There was no success in either tracheal intubation or laryngeal mask positioning maneuvers. The use of sugammadex at a dose of 16 mg.kg-1 was required and respiratory function returned to normal. CONCLUSION: Literature recommends sugammadex at a dose of 16 mg.kg-1 for patients with profound blockade. It was used in our patient with rapid and effective reversal of neuromuscular blockade allowing the patient to undergo another procedure to ensure the airway patency without clinical impairment of her general condition.

Keywords

Intraoperative Complications, Intubation, Cyclodextrin

References

Bom A, Bradley M, Cameron K. A novel concept of reversing neuromuscular block: chemical encapsulation of rocuronium bromide by a cyclodextrin-based synthetic host. Angew Chem Int Ed Engl. 2002;41:266-270.

Pühringer FK, Kristen P, Rex C. Sugammadex reversal of rocuronium: induced neuromuscular block in Caesarean section patients: a series of seven cases. Br J Anaesth. 2010;105:657-660.

Lemmens HJ, El- Orbany MI, Berry J. Reversal of profound vecuronium: induced neuromuscular block under sevoflurane anesthesia: sugammadex versus neostigmine. BMC Anesthesiol. 2010;10:15.

Epemolu O, Bom A, Hope F. Reversal of neuromuscular block and simultaneous increase in plasma rocuronium concentration after the intravenous infusion of the novel reversal agent Org 25969. Anesthesiology. 2003;99:632-637.

Rex C, Bergner UA, Pühringer FK. Sugammadex: a selective relaxant- binding agent providing rapid reversal. Curr Opin Anaesthesiol. 2010;23:461-465.

Lee C, Jahr JS, Candiotti KA, Warriner . Reversal of profound neuromuscular block by sugammadex administered three minutes after rocuronium: a comparison with spontaneous recovery from succinylcholine. Anesthesiology. 2009;110:1020-1025.

Pühringer FK, Rex C, Sielenkämper AW. Reversel of profound, high-dose rocuronium-induced neuromuscular blockade by sugammadex at two different time points. Anesthesiology. 2008;109:188-197.

Kopman AF, Zank LM, Ng J. Antagonism of cisatracurium and rocuronium block at a tactile train of four count of two: should quantitative assessment of neuromuscular function be mandatory?. Anesth Analg. 2004;98:102-106.

Khuenl-Brady KS, Wattwil M, Vanacker BF. Sugammadex provides faster reversal of vecuronium-induced neuromuscular blockade compared with neostigmine: a multicenter, randomized, controlled trial. Anesth Analg. 2010;110:64-73.

Eleveld DJ, Kuizenga K, Proost JH. A temporary decrease in twitch response during reversal of rocuronium-induced muscle relaxation with a small dose of sugammadex. Anesth Analg. 2007;104:582-584.

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